From the Guidelines
Toxic shock syndrome (TSS) is a severe and potentially life-threatening illness associated with invasive or noninvasive bacterial infections, characterized by signs of toxicity and a rapidly progressive clinical course.
Key Characteristics
- Rapid progression: TSS can progress rapidly, with a high case-fatality rate that may exceed 50% 1
- Toxicity signs: The condition is marked by signs of toxicity, which can occur with infection at any site, but most often occurs in association with infection of a cutaneous lesion 1
- Bacterial infection: TSS is associated with bacterial infections, including group A streptococcal (Streptococcus pyogenes) infection 1
Clinical Description
The clinical description of TSS includes a rapidly progressive clinical course and signs of toxicity, as outlined in the case definitions for infectious conditions under public health surveillance 1
Related Conditions
TSS is related to other conditions, including Streptococcal Toxic-Shock Syndrome and Streptococcal Disease, Invasive, Group A 1
From the Research
Definition and Causes of Toxic Shock Syndrome (TSS)
- Toxic shock syndrome (TSS) is a rare, life-threatening, toxin-mediated infectious process linked to toxin-producing strains of Staphylococcus aureus or Streptococcus pyogenes 2, 3, 4, 5, 6.
- The main described superantigenic exotoxins are toxic shock syndrome toxin-1 (TSST-1) and enterotoxins for Staphylococcus aureus and Streptococcal pyrogenic exotoxins (SpE) A, B, and C and streptococcal superantigen A (SsA) for Streptococcus pyogenes 2.
- TSS can be menstrual or nonmenstrual, with staphylococcal TSS being associated with tampon use, and streptococcal TSS being linked to a severe group A streptococcal infection and necrotizing soft tissue infection 2, 3, 5.
Symptoms and Diagnosis of TSS
- Early symptoms of TSS include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension 3, 5.
- Diffuse erythema and desquamation may occur later in the disease course 3.
- Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies 3, 5.
- Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis 3.
Treatment and Management of TSS
- Management of TSS is a medical emergency and relies on early detection, immediate resuscitation, source control and eradication of toxin production, bactericidal antibiotic treatment, and protein synthesis inhibiting antibiotic administration 2, 3, 4.
- Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid 3.
- Clindamycin is superior to penicillin in the treatment of TSS and significantly decreases the mortality rate 4.
- Early intensive care unit (ICU) and surgical team involvement (in selected cases) is required to avoid mortality 4.